Successful treatment of flecainide overdose with sustained mechanical circulatory support

Mandawat, Anant; McCullough, Stephen; Gilstrap, Lauren; Yeh, Robert W.

doi:10.1016/j.hrcr.2015.01.003

Cited by 10 publications

(12 citation statements)

References 15 publications

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“…13 While ECLS initiation can be decided according to the severity of cardiac failure based on LVEF and the usual organ perfusion markers, recurrent drug-induced arrhythmia may represent an accurate ECLS indication. 32,36,38 Due to the high predisposition to rhythm disturbance, indications in SCB poisonings can be triggered by tachyarrhythmia like ventricular tachycardia or ventricular fibrillation. 31,34,36,38 However, severe bradycardia was also reported in SCB-poisoned patients, 30,32,42 like CCBs and BBs usually associated with bradyarrhythmia, pulseless electrical activity and andasystole.…”

Section: Discussionmentioning

confidence: 99%

“…One patient was treated with a combination of exclusive vasoconstrictors without inotropic effect before ECLS initiation. 36 Overall, LVEF was severely decreased to 10%-35%. 32,33,35,40,41 Interestingly, some patients had plasma potassium as low as 1.8 mmol/ L, 33,37,41 resulting from intracellular transfer in massive SCB overdose and leading to worse prognosis.…”

Section: Ecls To Treat Scb-poisoned Patientsmentioning

confidence: 96%

“…29 Intravenous sodium salts like sodium bicarbonate and beta 1 -adrenergic receptor agonists are used to counter SCB effect in combination with catecholamines including epinephrine, the most frequently used in published cases (Table 3). [30][31][32][33][34][35][36][37][38][39][40][41][42][43][44] In SCB poisonings, ECLS was indicated in severe cardiovascular failure and refractory/recurrent cardiac arrest. ECLS was initiated in patients with organ hypoperfusion and lactate concentrations ranging from 5.7 to 10.8 mmol/L (Table 3).…”

Section: Ecls To Treat Scb-poisoned Patientsmentioning

confidence: 99%

“…32,33,35,40,41 Interestingly, some patients had plasma potassium as low as 1.8 mmol/ L, 33,37,41 resulting from intracellular transfer in massive SCB overdose and leading to worse prognosis. 45 Wide QRS complexes (0.14 to 0.22 s) were found [31][32][33]36,[42][43][44] and considered as characteristic of the SCB effect. The reported ECLS durations was between 7 h and 8 days.…”

Section: Ecls To Treat Scb-poisoned Patientsmentioning

confidence: 99%

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Extracorporeal life support in cardiotoxicant poisoning—A narrative review

Voicu

M’Rad

Malissin

et al. 2022

Basic Clin Pharma Tox

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Extracorporeal life support (ECLS) improves circulation in life‐threatening cardiac dysfunction or arrest patients. Its benefits in drug‐induced cardiovascular complications are debated. Indications and outcomes are poorly established. We performed a narrative review discussing ECLS indications, timing and results in cardiotoxicant‐poisoned patients. The review was focused on antiarrhythmic drugs and aluminium phosphide. Literature analysis was limited to the past 30 years in adults. Most reports were single cases and retrospective except one prospective case series of limited size, two of them controlled. ECLS indications and timing were at the discretion of physicians in charge but mostly included persistent cardiovascular failure despite elevated doses of inotropic/vasopressor support associated with elevated blood lactate concentrations (usually, >5 mmol/L) and collapsed left ventricular ejection fraction (LVEF; usually, ≤40%). Survival improved using ECLS versus standard care in one study. Survival was ~80% if ECLS was implemented in refractory cardiovascular failure and 25%–66% if implemented in cardiac arrest. In two controlled studies, survival of ECLS‐treated aluminium phosphide‐poisoned patients was improved versus standard care, if implemented in the presence of systolic blood pressure ≤80 mmHg despite inotropic/vasopressor treatment, arterial pH ≤ 7.0 and LVEF ≤ 40%. Despite low‐to‐moderate level of evidence, ECLS seems effective to improve survival in selected cardiotoxicant‐poisoned patients. Selection criteria need clarification.

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Section: Discussionmentioning

confidence: 99%

Section: Ecls To Treat Scb-poisoned Patientsmentioning

confidence: 96%

Section: Ecls To Treat Scb-poisoned Patientsmentioning

confidence: 99%

Section: Ecls To Treat Scb-poisoned Patientsmentioning

confidence: 99%

See 2 more Smart Citations

Extracorporeal life support in cardiotoxicant poisoning—A narrative review

Voicu

M’Rad

Malissin

et al. 2022

Basic Clin Pharma Tox

View full text Add to dashboard Cite

show abstract

“…7 In the adult population where polypharmacy is common, drug interactions with tricyclic antidepressants and amphetamines can enhance toxicity by additive sodium channel blockade. 6,8 As flecainide levels become supratherapeutic, cardiogenic shock ensues rapidly and can be refractory to chronotropic and inotropic therapies. The electromechanical dissociation from VT, as seen in our patient, can further worsen end-organ perfusion, especially to the kidneys and liver, which are involved in its elimination pharmacokinetics.…”

Section: Discussionmentioning

confidence: 99%